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Parvovirus y Otras Hepatitis en Niños
Parvovirus y Otras Hepatitis en Niños
RESULTS
In the initial phase a total of 48 patients with FHF were
included in the study. One or more viral markers were detected in
26 patients either in the serum samples or liver tissue. Of 48
patients B19 genome was present in 19 (39%), of which 13 (27%)
were also positive for IgM antibodies against one or more other
hepatotropic viruses (HAV in 3 patients, HBV in 6 patients, HCV
in 2 patients, and HAV plus HEV in 2 patients). In patients
negative for B19 genome (n 29), 7 (15%) patients showed the
presence of IgM antibodies against one hepatotropic virus each
(HBV in 3; HCV in 2; and HAV and HEV in one patient each).
Among biliary atresia cases B19 genome (DNA) was detected in
11 of 79 cases. PCR-positivity in FHF cases was significantly
higher (P 0.0022) and the risk was increased 4-fold (OR
4.05; 95% CI 1.719.58).
B19 mRNA was detected in 19 (39%) of 48 liver tissue
specimens from FHF cases. Presence of B19 mRNA in the liver
tissue correlated with the presence of B19 genome in the serum
samples. Among the biliary atresia cases B19 mRNA was
present in only 8 of 79 (10.1%). Association of B19 mRNA and
FHF cases differed significantly with that of biliary atresia
cases (P 0.0002) and the risk was found to be 6-fold
(OR 5.82; 95% CI 2.29 14.77).
Clinical characteristics and laboratory findings of patients in
the 3 groups were compared. The groups were found age matched.
The main distinctive features of parvovirus B19 and other hepatitis
viruses coinfection associated FHF were: presence of jaundice,
high bilirubin, high alanine aminotransferase or aspartate aminotransferase activity, and unfavorable outcome resulting in death of
most of the patients (Table, Supplemental Digital Content 1,
http://links.lww.com/A1140). Results of statistical analyses are
summarized in the Table 1.
DISCUSSION
Association of fulminant or acute hepatitis with B19 infection has been previously reported.4,5 The causal association of B19
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649
The Pediatric Infectious Disease Journal Volume 28, Number 7, July 2009
Vaillant et al
Clinical characteristics
Fever-present
Fever-absent
Rash-present
Rash-absent
Jaundice-present
Jaundiceabsent
Outcome
Alive
Dead
B-19 Alone
(n 6)
2
4
2
4
1
5
5
8
2
11
11
2
3
4
0
7
4
3
0.94
6
0
3
10
3
4
0.0074*
0.2519
0.0175*
650
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